Whether Medicare, Medicaid or Private Pay (commercial), Steve Ungar has worked cases on behalf of healthcare professionals for over 40 years. He is nearly always successful in negotiating settlement with government auditors and diverting cases from criminal referral. He also has an excellent record of “no action” audit results.

It usually starts with a records request. A Medicare contractor, a state Medicaid unit, or a commercial payer’s special investigations unit wants charts, billing records, documentation. It reads like paperwork. It is the opening move of a process that can end in recoupment demands, extrapolated overpayments, exclusion from federal programs, licensing board referrals, or a criminal case. How you respond to that first request shapes everything after it.

Every Audit Has a Direction

Healthcare audits escalate by design. A sample of claims becomes an extrapolated overpayment across years of billing. A documentation dispute becomes an allegation of a pattern. A civil audit file lands on a prosecutor’s desk. Our work is to stop that escalation early: challenge the sample, contest the extrapolation, correct the record, and keep a billing dispute from being recast as fraud.

Forty Years on These Cases

Steve Ungar has represented healthcare professionals in audits and investigations for over four decades, across Medicare, Medicaid, and commercial payers. The pattern in that work is consistent: matters resolved through negotiated settlements with government auditors, cases diverted from criminal referral, and audits closed with no action taken at all. The quiet result is the goal. It is also, in his experience, the usual one.

The Collateral Consequences Are the Case

For a healthcare professional, the overpayment demand is rarely the worst risk on the table. Exclusion from Medicare and Medicaid can end a practice. A fraud finding can reach your professional license and follow you through data banks and credentialing for years. We defend the audit with every one of those consequences in view, because resolving the billing issue while losing the license is not a resolution.

What We Do

  • Medicare audit response: MACs, RACs, UPICs, and program integrity contractors
  • Medicaid audits and state program integrity investigations
  • Commercial payer and special investigations unit (SIU) audits
  • Statistical sampling and extrapolation challenges
  • Self-disclosure protocols and negotiated repayments
  • Compliance reviews and program design, with our regulatory practice
  • Diversion of matters from criminal referral, and defense when charges threaten
  • Coordination with licensing board counsel when boards take interest

Who We Help

Physicians and medical groups. Nurses and nurse practitioners. Dentists, psychologists, therapists, and behavioral health providers. Clinics, treatment centers, and the organizations that run them. If a payer can audit you, we can defend you.

Before You Send a Single Chart

Practices often respond to records requests without counsel, reasoning that the billing was honest so the audit will be fine. Honest billing defended casually still produces extrapolated overpayments. Call before you respond to an audit letter or records request. The record you build in the first response is the one the auditor works from.